Specialised Ambulance Speeds Earlier Treatment for Stroke Patients

An ambulance designed specifically for
stroke treatment improved the treatment time for ischaemic strokes, thanks to
specialised onboard equipment and staffing. These are the findings of a German
study published in JAMA’s neurology-themed April 23/30 issue.

Stroke leads to disability or death for
thousands of people each year, with time a critical factor for more favourable
outcomes. Acute ischaemic stroke is sometimes treated by dissolving the blood
clot, or thrombus, through the intravenous administration of tissue plasminogen
activator (tPA), a process known as thrombolysis. Thrombolysis is the preferred
treatment when brain-bleeding has been excluded by imaging.

Early treatment by tPA is associated with
better prognosis for patients presenting with acute ischaemic stroke, with the
recommendation of 60 minutes or less from their arrival to the time of
injection. However, data from American research indicates that less than a
third of patients (30%) meet this standard, thanks to delays in presentation as
well as crisis management outside and inside the hospital. A recent study found
that a specialised ambulance contributed time-savings for tPA injections for 12
patients who benefited from the vehicle’s point-of-care technology, including a
computed tomography (CT) scanner and laboratory.

An ambulance designed specifically for
stroke treatment can improve treatment times for patients who have suffered an
ischaemic stroke. The specialised vehicle, called Stroke Emergency Mobile or
“STEMO”, features a CT scanner, an on-site laboratory and telemedicine
capability, operated by a pre-hospital team of stroke specialists which
includes a neurologist, a paramedic and a radiology technician. The ambulance
also has a tool that helps to identify stroke patients at the level of the emergency
dispatcher.

In the Berlin-based study led by Martin
Ebinger, M.D. of Charité–Universitätsmedizin, the STEMO was available for
response to emergency calls during a limited number of weeks, assigned at
random. Confirmations of ischaemic stroke led to the initiation of thrombolysis
when contraindications were excluded. The study showed that “the
ambulance-based thrombolysis was safe, reduced alarm-to-treatment time, and
increased thombolysis rates,” according to the study’s authors.

Key findings of the study, which included a
patient population of 6,182 people, include a time reduction of 25 minutes from
a dispatcher-activated alarm to tPA treatment, compared to control weeks when
the STEMO was not assigned. There was also a higher rate of tPA treatment
following STEMO deployment compared to control weeks (33 percent versus 21
percent).

There was no associated higher risk for
intracerebral haemorrhage or for 7-day mortality for patients who were
transported to hospital by STEMO vehicles. Additional studies will assess
clinical outcomes for patients.

Furthermore, a cost analysis is currently
being conducted to weigh the study’s effects against concept costs. Each STEMO
vehicle comes with a price tag of approximately $1.4 million, depending on
configuration of the ambulance.

Berlin has 14 stroke units which comprise
an established stroke care system.

A recent study has found an association between baseline P-wave morphology and subsequent ischemic stroke risk. The study was...
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Stroke, Ambulance, Emergency, ischemic stroke, first aid, treatment time
An ambulance designed specifically for
stroke treatment improved the treatment time for ischaemic strokes, thanks to
specialised onboard equipment

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